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Male Injecting-drug Users At Greater Risk Of Drug-related Death (p 941)

September 17, 2003

A study of injecting-drug users in Scotland in this week's issue of THE LANCET highlights how men-and all injectors over 34 years of age-have the highest drug-related mortality risk. The study also focuses on the need for drug-related deaths to be assessed in relation to the estimated number of injecting-drug users (rather than overall population data) for reliable conclusions to be drawn about regional or age-related drug-related mortality risk.

In 2000 and 2001 there were 292 and 332 drug-related deaths in Scotland, respectively. Of the 332 people who died in 2001, 65 were women, 80 were younger than 25 years, and 112 were older than 34 years. Sheila Bird from the Medical Research Council's Biostatistics Unit, Cambridge, UK, and colleagues from the Scottish Centre For Infection and Environmental Health assessed the effect of region, sex, and age group on drug-related deaths in Scotland per 100 injecting drug users.

The investigators used published regional estimates of Scotland's current injecting drug users (totalling 22,805), their gender (30% female) and age distribution (older than 34 years: between 8% and 21% depending on data-source) to compare observed with expected drug-related deaths by region, gender, and age group per 1000 population or per 100 injecting drug users.

The risk of drug-related death was lower among female injecting-drug users than male injecting-drug-users (0.9 and 1.5 per 100 injecting-drug users, respectively). Injecting-drug users over 34 years of age were between two and six times more likely to die of drug-related causes than injecting-drug users younger than 25 years.

Sheila Bird comments: "The public health messages of "stop injecting" and "never initiate into injecting" stand, but we have shown that cessation of injecting, as a goal, might be particularly critical for older injecting drug users. Unacceptable uncertainty remains about whether older drug users' risk of drug-related death is twice or six times that of younger users. Prioritisation of clients by drug treatment centres may depend on which rate is correct. Our analyses underline the call by the UK's Advisory Council on the Misuse of Drugs for international research on drug-related deaths and injecting drug users' risk factors for drug-related death. Particular attention should be paid to the role of modifiable risk factors, such as incarceration, living or injecting alone, and risk perception - for example by males versus females. Life years lost from drug-related deaths are converging on the number of lost years from road traffic accidents-as the former goes up, the latter is coming down."

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